Yallappa Sachin, Amer Tarik, Jones Patrick, Greco Francesco, Tailly Thomas, Somani Bhaskar K, Umez-Eronini Nkem, Aboumarzouk Omar M
1 Glasgow Urological Research Unit, Department of Urology, Queen Elizabeth University Hospital , Glasgow, United Kingdom .
2 Department of Urology, School of Medicine, Dentistry & Nursing, University of Glasgow , Glasgow, United Kingdom .
J Endourol. 2018 May;32(5):371-379. doi: 10.1089/end.2017.0848. Epub 2018 Apr 24.
Ureteral colic has a lifetime prevalence of 10%-15% and is one of the most common emergency urologic presentations. Current European Association of Urology recommends conservative management for "small" (<6 mm) ureteral stones if active removal is not indicated. It is important to understand the natural history of ureteral stone disease to help counsel patients with regard to their likelihood of stone passage and anticipated time frame with which they could be safely observed. We aimed to conduct a systematic review to better establish the natural history of stone expulsion.
Literature search was performed using Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Outcome measures were patient and stone demographics, expulsion rates, expulsion times, and side effect of the medication. A cumulative analysis, with subgroup analysis, was performed on stone location and size. The results were depicted as percentages and an intention-to-treat basis was used.
The literature search identified 70 studies and a total of 6642 patients, with a median age of 46 and range of 18-74 years. Overall, 64% of patients successfully passed their stones spontaneously. About 49% of upper ureteral stones, 58% of midureteral stones, and 68% of distal ureteral stones passed spontaneously. Almost 75% of stones <5 mm and 62% of stones ≥5 mm passed spontaneously. The average time to stone expulsion was about 17 days (range 6-29 days). Nearly 5% of participants required rehospitalization due to a deterioration of their condition and only about 1% of patients experienced side effects from analgesia provided.
We believe this current review is the largest study for the evaluation of natural history of ureteral stones. The evidence suggests that ureteral stones will pass without intervention in 64% of patients, however, this varies from nearly 50%-75% depending on the size and location, in the span of 1-4 weeks.
输尿管绞痛的终生患病率为10%-15%，是泌尿外科最常见的急症之一。欧洲泌尿外科学会目前建议，对于“小”（<6毫米）输尿管结石，若未表明需积极取出，则采取保守治疗。了解输尿管结石疾病的自然病程对于向患者提供结石排出可能性及安全观察预期时间框架的咨询建议很重要。我们旨在进行一项系统评价，以更好地确定结石排出的自然病程。
按照Cochrane和PRISMA（系统评价与Meta分析的首选报告项目）指南进行文献检索。结局指标为患者和结石的人口统计学特征、排出率、排出时间以及药物副作用。对结石位置和大小进行了累积分析及亚组分析。结果以百分比表示，并采用意向性分析。
文献检索共纳入70项研究，总计6642例患者，中位年龄为46岁，年龄范围为18-74岁。总体而言，64%的患者结石自行排出。上输尿管结石约49%、中输尿管结石约58%、下输尿管结石约68%自行排出。直径<5毫米的结石近75%以及直径≥5毫米的结石62%自行排出。结石排出的平均时间约为17天（范围为6-29天）。近5%的参与者因病情恶化需要再次住院，仅约1%的患者出现所提供镇痛药物的副作用。
我们认为本次综述是评估输尿管结石自然病程的最大规模研究。证据表明，64%的患者输尿管结石无需干预即可排出，然而，根据结石大小和位置不同，这一比例在1-4周内介于近50%-75%之间。
